MORE than 480 children have died and thousands more have fallen ill in Bangladesh’s measles outbreak this year. At the same time, the president has been travelling abroad for medical consultations. These are not unrelated events. Read side by side, they expose the deepest fault line in Bangladesh’s public health system: one pathway for those who can purchase safety and another for those condemned to depend on a system its own leaders do not trust.
Measles is neither rare nor incurable. It is prevented by a vaccine that costs only a few dollars and has been available for over 60 years. Yet in the crowded slums of Dhaka, in remote northern districts, and in the settlements of Cox’s Bazar, children continue to die from a disease the world learnt to stop decades ago. Each death is not an unavoidable tragedy — it is a record of institutional failure.
Numbers are shameful
BANGLADESH’S healthcare breakdown did not emerge overnight. It is the cumulative result of decades of neglect, chronic underinvestment, weak governance, and the persistent relegation of health within national priorities. Bangladesh spends approximately 2 per cent of its GDP on health — one of the lowest rates in South Asia. More than 70 per cent of total health expenditure comes directly from people’s own pockets, turning illness into one of the country’s most powerful drivers of poverty.
The shortage of healthcare personnel runs just as deep. There are currently only 5.26 doctors per 10,000 people — well below the minimum standard set by the World Health Organisation. Public hospitals remain chronically overcrowded and under-resourced. Doctors work under relentless pressure amid inadequate infrastructure, medicine shortages, and overwhelming patient loads. Rural upazila health complexes face persistent staffing shortages, while community clinics frequently lack reliable equipment. For citizens without money, connections, or political access, the system often fails precisely when survival depends upon it.
These failures are starkly visible in routine public health operations. In rural areas across the country, vaccination outreach remains irregular because of staffing shortages, logistical breakdowns, and failures in the cold-chain systems needed to preserve vaccines safely. These are not abstract administrative deficiencies — they determine whether a child receives life-saving immunisation on time or remains vulnerable to a disease that should no longer be fatal. This structural neglect unfolds against an already worsening backdrop: Bangladesh now faces a double burden of disease, with communicable illnesses persisting alongside a rapid rise in diabetes, heart disease, and other non-communicable conditions — pressures that climate change will only intensify.
Signal leaders send
THERE is nothing unlawful about a president seeking medical care abroad. Any person with resources would pursue the best available treatment. The issue is not the individual decision. The issue is the institutional signal it sends — and what accumulates when that signal is repeated across an entire political class.
Political leadership operates through symbols as much as through policy. When presidents, ministers, and senior officials routinely fly to Singapore, Bangkok, London, or Delhi for treatment they could not reliably obtain at home, they communicate, without a word, that the public system cannot be trusted with lives that matter. That signal travels downward. It reaches the nurse in Rangpur working with broken equipment. It reaches the family in Mymensingh, calculating whether they can afford a private clinic. It reaches every citizen who has absorbed, correctly, that the healthcare system is a hierarchy of safety: the powerful opt out, and the rest manage with what remains.
Political scientists describe this as ‘elite exit’ — the withdrawal of the powerful from public institutions they govern. Its consequences are institutional as well as symbolic. When decision-makers have no personal dependence on a system, reform loses urgency. The system deteriorates. More people exit. Two parallel healthcare worlds solidify: one insulated by wealth and international mobility, the other trapped in chronic scarcity. A society cannot sustain strong public institutions when those with the greatest power to improve them have the least personal reason to do so.
Crisis of governance
THE healthcare crisis is also, fundamentally, a crisis of governance — and that crisis has a specific shape. In Bangladesh, development priorities are heavily influenced by political visibility. Bridges, expressways, and flyovers generate immediate, photographable symbols of progress. Investments in cold-chain infrastructure, vaccination outreach, or primary care capacity generate health outcomes over years, quietly, diffusely, and without ribbon-cutting ceremonies. The result is a structural bias in which the health sector remains persistently underfunded relative to its importance.
According to the World Bank’s 2023 governance index, Bangladesh ranks 113th out of 195 countries in health governance — far behind both India and Sri Lanka. Research by the Bangladesh Institute of Development Studies finds that nearly 60 per cent of leadership positions in the health sector are filled through political influence, meaning loyalty consistently takes precedence over professional competence. Delayed procurement of dengue testing kits, sluggish responses to vaccination campaigns — these are not isolated incidents. They are symptoms of a structurally weakened institutional framework.
Financial mismanagement and procurement corruption compound the problem significantly. According to World Bank data from 2023, corruption causes approximately 30 per cent of the health budget to be wasted each year. A 2024 study by the Asian Development Bank found that at least 40 per cent of medical equipment is procured at inflated prices, and around 35 per cent lies idle for want of maintenance. Tender processes may be formally competitive, but in practice, political interference, middlemen, and weak oversight systematically undermine the efficient use of already limited resources.
The crisis extends into the private sector as well. While thousands of private hospitals and clinics have expanded rapidly across the country, a substantial number continue operating without valid licences or outside meaningful regulatory oversight. This is not a minor administrative gap. It directly undermines patient safety, erodes standards of care, and quietly hollows out public trust in the healthcare system, at precisely the moment that trust is most needed.
A moral question
THE crisis is therefore not merely administrative — it is fundamentally ethical. The World Health Organisation and the United Nations human rights framework recognise healthcare as a basic human right. Article 15 of Bangladesh’s own Constitution acknowledges health as a component of citizens’ fundamental rights. Accordingly, children dying from preventable diseases is not merely a policy failure — it is evidence of the state’s failure to fulfil its core obligations.
The economist Amartya Sen linked development to the expansion of people’s real capabilities. A child who receives no vaccine is stripped of the most fundamental capability of all — the ability to live in good health. The philosopher John Rawls argued that in a just society, state institutions must be designed above all to protect those who are most vulnerable. Bangladesh’s healthcare system has yet to pass that test. When a preventable death becomes routine, it is not only a family that grieves — it is a state that has quietly abandoned its most basic promise to its citizens.
Question of priorities
PUBLIC health is not merely a social service — it is a matter of national security, economic stability, and the fundamental capacity of the state. When a country fails to ensure that its children are vaccinated, the impact of that failure does not remain confined to hospitals. It strikes the workforce, education, productivity, and social stability alike.
Countries such as Rwanda and Vietnam have succeeded in dramatically reducing deaths from preventable diseases by elevating immunisation to a national priority, securing sustainable funding, and ensuring effective grassroots participation. Indonesia’s JKN programme has extended the reach of universal health coverage; Malaysia has built an integrated public-private system; and Thailand’s ‘30 Baht Scheme’ has demonstrated that broad public health protection is achievable at low cost — if the political will exists. The question is not one of capacity. It is about political priority.
In this context, urgent action is needed across at least four fronts:
First, immunisation programmes and primary healthcare must be brought under sustained, dedicated funding and treated as a matter of national security — not discretionary spending subject to annual political calculus.
Second, substantial investment is needed in district hospitals, specialist care, and human resource development. The measure of success is straightforward: the country’s own leadership should be willing to trust its hospitals with their lives.
Third, the burden of healthcare costs, now borne more than 70 per cent by ordinary citizens out of their own pockets, must be progressively transferred to the state. Inclusive development is impossible without an effective health protection system that does not impoverish those it treats.
Fourth, procurement transparency, effective regulation of the private sector, and investment in digital health information systems are indispensable. Increasing the budget without reforming how money is spent will not deliver the change that is needed.
Conclusion
HEALTHCARE is not a luxury. It is one of the foundational pillars of a state’s legitimacy, of social justice, and of citizens’ dignity. Bangladesh does not lack skilled doctors, public health specialists, or healthcare workers. What it lacks is long-term political commitment — to transparency, accountability, institutional efficiency, and professionalism. What it lacks is the will to treat health not as a seasonal promise, but as a strategic investment in human development and national stability.
A country’s true strength is not measured by its ability to secure treatment abroad for its powerful. It is measured by its capacity to keep even its poorest child alive. So long as children continue to die for want of a vaccine costing a few dollars, while the powerful seek safety in foreign hospitals, Bangladesh’s story of development will remain morally incomplete.
This is not misfortune. It is unjust.
Golam Rosul is a professor of economics at the International University of Business, Agriculture and Technology.
